| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $599.90 | $599.90 | $599.90 | |
Aetna
| Professional | $65.91 | $65.91 | $376.39 | |
Cigna
| Professional | $313.11 | $313.11 | $313.11 | |
Horizon BCBS
| Facility | $1,035.26 | $1,035.26 | $2,102.54 |